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Loxatine Drug-We Should Know It!

Loxitane (Generic) belongs to the group of psychotropic drugs, the most widely prescribed for the elderly; in particular, they receive 5-8% of patients who are in psychiatric institutions. Antipsychotics are indicated for the treatment of psychotic disorders, including schizophrenia, delusional disorder, certain organic psychoses, and psychotic symptoms in affective disorders.
More than 80% of patients with dementia at some point have behavioral and mental disorders, such as agitation, aggression, and psychosis.

These symptoms are painful for the sick and burdensome for the caregivers. Because of these symptoms, patients are often placed in facilities for permanent residence. At present, Loxitane (Generic) remains the only established pharmacological method for the treatment of behavioral and mental disorders in dementia.

The improvement of Loxitane (Generic) with demonstrated viability and better averageness ought to convey unique advantages to old patients, particularly with dementia. New atypical Loxitane (Generic) with these properties have on a fundamental level changed the treatment of youthful schizophrenia patients. Concentrates that have contemplated these patients have appeared new atypical antipsychotics are as (or increasingly) successful as a run of the mill antipsychotics.

Additionally, they decrease negative manifestations all the more especially and cause extrapyramidal side effects and late dyskinesia more rarely. But is there any evidence that atypical Loxitane (Generic) are useful in the treatment of psychotic disorders caused by the mental illness of a later age? And if so, what are their specific advantages over typical Loxitane (Generic)? Is it possible, by an increasing volume of literature, to draw up proper guidelines for the use of atypical antipsychotic medications for mental disorders of late age?

We begin with a brief review of the indications for prescribing Loxitane (Generic) and describing the properties that make them atypical. Then we consider the features of their use in the elderly, pharmacokinetic and pharmacodynamic changes during aging, concomitant somatic diseases, drug interactions, and tolerability. Next, we discuss the specific pharmacological properties of each atypical antipsychotic drug, its effectiveness and side effects. In conclusion, we present some general recommendations.

MENTAL DISTURBANCES WITH PSYCHOTIC SYMPTOMATIC AND BEHAVIOR DISORDERS IN ELDERLY PEOPLE
Psychotic symptoms and behavioral disorders often accompany many common mental disorders in older people. Different forms of dementia are much more common than other diseases.
Due to the strict licensing rules adopted in America and Europe, and the influence of the market, pharmaceutical companies, did not show sufficient activity to give the right to use new atypical antipsychotics in older adults. Although recently sold antipsychotics are allowed to be prescribed only to young patients who have schizophrenia, in psychiatry of a later age they are widely used for the symptomatic treatment of some disorders. In the United States, by the end of 1999, of all prescribed Loxitane (Generic), atypical antipsychotics accounted for 61%.

Typical Loxitane (Generic) is still the primary treatment for behavioral and mental disorders in dementia. However, evaluations of the effectiveness of these drugs in the treatment of behavioral syndromes complicating dementia are relatively modest. Schneider and colleagues (1990) conducted a thorough meta-analysis of the results of seven double-blind, placebo-controlled studies involving parallel groups. In these studies, subjects were studied with a probable diagnosis of primary degenerative or vascular dementia. The results showed that typical antipsychotics were significantly more effective than placebo.

Although the effect was insignificant, the authors indicated that low doses were used in the study of patients with dementia compared with the effective treatments in young patients. Data from Schneider and colleagues confirmed a later meta-examination of the aftereffects of 16 randomized, twofold visually impaired, controlled preliminaries of the viability of treatment of social and mental issue (directed in 1966 and 1998) in more established grown-ups.

Extrapyramidal symptoms
Extrapyramidal indications are the most public reactions that happen with an antipsychotic prescription. These manifestations are agonizing for the wiped out and inadequately analyzed. Older patients have these indications very rapidly, particularly akathisia, parkinsonism, and tardive dyskinesia. The principal signs of parkinsonism of any etiology are a ternion of manifestations: bradykinesia, stable unbending nature, and tremor. Among older patients in people with Alzheimer’s ailment or dementia-related with Lewy bodies, parkinsonism appears to develop particularly often under the influence of drugs.

The emergence of extrapyramidal symptoms causes such undesirable effects: the tolerance of the drug is aggravated, the dosage regimen is not complied with, the incidence of incidence is increasing, etc. These facts in and of themselves force the use of Loxitane (Generic) in elderly patients very carefully.

Tardive dyskinesia
Tardive dyskinesia is one of the most severe side effects regarding its frequency, invariance, irreversibility, and influence on the general well-being of a person. Its significance appears to be increasing, given the medical and legal consequences in the future. With age, both the risk of tardive dyskinesia and its severity rise significantly. Cumulative incidence rates of tardive dyskinesia after a year, two, and three years of exposure to typical Loxitane (Generic) for elderly patients, respectively, reach 26, 52, and 60%, while for younger patients, these figures are 4, 8 and 11%.

The risk of developing late dyskinesia in elderly patients is high even with relatively short treatment with low doses of typical Loxitane (Generic). In young adults, the low risk of tardive dyskinesia with atypical antipsychotics has been convincingly confirmed; it is also likely to be the same in elderly patients.

Falls and orthostatic reaction
The incidence of orthostatic hypotension in older people ranges from 5 to 33% and increases with age (Verhaeverbeke & Mets, 1997). Orthostatic hypotension is a common side effect of several drugs, including antipsychotics, and the leading cause of falls with adverse effects, such as bone fractures, injuries, decreased functioning, dependence, and death. Loxitane (Generic) to varying degrees are capable of causing orthostatic hypotension, while typical Loxitane (Generic) and clozapine were among the most problematic.

Anticholinergic side effects of Loxitane (Generic) and their impact on cognitive activity
In older adults, anticholinergic side effects are particularly easy to manifest, including constipation, glaucoma, dry mouth, urinary retention, cognitive impairment, and delirium. Since elderly patients with psychotic symptoms often experience cognitive impairment of varying degrees, it is essential that treatment methods have a minimal risk of further enhancing these disorders. Atypical antipsychotics, especially risperidone and quetiapine, have a weaker affinity for binding to acetylcholine receptors and, to a lesser extent, cause anticholinergic effects.

It has been reported that elderly patients with dementia experienced relatively fast cognitive functions during treatment with typical Loxitane (Generic). In experimental and clinical studies, there is increasing evidence that cognitive impairments associated with antipsychotics in older adults can be explained by the inhibitory effects of these drugs on dopaminergic, cholinergic and histamine neurochemical systems. The impact of a particular antipsychotic medication on cognitive functions in older adults is likely to be due to its pharmacodynamic action in combination with the pathophysiological processes underlying the condition about which the patient is receiving treatment. Data from a review of studies that investigated the effects of

Loxitane (Generic) on cognitive functions in elderly patients suggest that atypical antipsychotic medications in this population have a more beneficial effect on cognitive tasks than typical neuroleptics.

Many published clinical articles confirm the side effects of various Loxitane (Generic) (as well as other commonly used psychotropic drugs, such as tricyclic antidepressants) from the heart. Typical antipsychotic medications can cause sudden death, an increase in the QT interval, and flutter-blink at therapeutic and toxic doses. In 1963, Kelly and colleagues, who described two deaths caused by thioridazine, first reported this. Haloperidol, chlorpromazine, trifluoperazine, periciazine, prochlorperazine, and fluphenazine can cause similar complications, but most of all it concerns thioridazine. It is well known that pimozide causes an increase in the QT interval and flutter-blink. Between 1971 and 1995, the Drug Safety Control Committee reported 40 cases of severe heart complications, including 16 deaths (Committee on Safety of Medicines & Medicines Control Agency, 1995). Sertindole caused 36 deaths, resulting in its production being suspended (Committee on Safety of Medicines & Medicines Control Agency, 1999). Reilly and colleagues (2000) evaluated the effects of several psychotropic drugs, including typical Loxitane (Generic), clozapine, and risperidone, on the QT interval and revealed four significant independent predictors of an increase in the QT interval: age over 65, tricyclic antidepressants, droperidol, tee thioridazine. An association has also been established between increasing the QTc interval and increasing the dose of the antipsychotic drug.

Other effects of Loxitane (Generic)
Among other side effects of Loxitane (Generic), sexual dysfunction is observed, most pronounced with high anticholinergic and a-adrenergic activity, as well as an increase in body weight, especially marked with the treatment of atypical drugs clozapine and olanzapine; typical Loxitane (Generic) is risperidone cause hyperprolactinemia, which can later cause osteoporosis. New atypical Loxitane (Generic) is less likely to cause the neuroleptic malignant syndrome.
Studies of atypical antipsychotic drugs in a population of young adult patients have demonstrated their effectiveness in treating productive and negative symptoms, while they did not cause extrapyramidal signs or these symptoms were minimal.

Also, the risk of tardive dyskinesia or dystonia was low. Based on the evidence-based practice of using atypical drugs in elderly patients, the number of positive results of treatment is increasing, although there are few double-blind, placebo-controlled trials (“gold standard”). Most of the evidence was obtained in several experiments, both prospectively and retrospectively, without using the comparison method, as well as in studies of a series of cases and from individual reports.


Among other side effects of Loxitane (Generic), sexual dysfunction is observed, most pronounced with high anticholinergic and a-adrenergic activity, as well as an increase in body weight, especially marked with the treatment of atypical drugs clozapine and olanzapine; typical Loxitane (Generic) is risperidone cause hyperprolactinemia, which can later cause osteoporosis. New atypical Loxitane (Generic) is less likely to cause the neuroleptic malignant syndrome.

Studies of atypical antipsychotic drugs in a population of young adult patients have demonstrated their effectiveness in treating productive and negative symptoms, while they did not cause extrapyramidal signs or these symptoms were minimal. Also, the risk of tardive dyskinesia or dystonia was low. Based on the evidence-based practice of using atypical drugs in elderly patients, the number of positive results of treatment is increasing, although there are few double-blind, placebo-controlled trials (“gold standard”).

Most of the evidence was obtained in several experiments, both prospectively and retrospectively, without using the comparison method, as well as in studies of a series of cases and from individual reports.

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